Keys to Lively Sex Life for Women with Drs. Linda Bradley and Dana Brendza

Podcast Transcript

Nada Youssef:   Hi. Thank you for joining us. I'm your host, Nada Youssef. As we continue our celebration of women's health this month, we are putting you first by bringing on not one, but two experts, to discuss women's sexual health. Sexual health is essential for our overall physical and emotional well-being. A fulfilling sex life can reduce a lot of stress in our lives, improve our mental health, and even improve our quality of sleep.

Our featured experts for this topic today: Vice-Chair of Obstetrics, Gynecology, and Women's Health, Dr. Linda Bradley. Thank you for being here. And also, we have clinical health psychologist Dr. Dana Brendza. Thank you. Thank you for being here.

Before we get started, please remember this is for informational purposes only and not intended to replace your own physician's advice.

Thank you, ladies, again for being here. I'm going to give you a few moments to introduce yourself. We can start off with you.

Linda Bradley:   Hi. I'm again, Dr. Linda Bradley. I'm actually Vice-Chair of OB/GYN at the Cleveland Clinic and see women for a host of problems. Some sexual dysfunction issues or sexual concerns, but also a strong interest in evaluating women for abnormal bleeding, giving women second opinions to avoid hysterectomy and looking when they do need surgery, more minimally invasive techniques and technologies to allow them short stays in hospital, rapid recovery, and good outcomes.

Nada Youssef:   Great. Thank you.

Linda Bradley:   Mm-hmm (affirmative).

Nada Youssef:   And Dr. Brendza. Do you want to introduce yourself?

Dana Brendza:  Yes. I'm Dana Brendza, and I'm a clinical health psychologist, and one of the hats that I wear here is I treat patients with sexual dysfunction, both men and women, and I also treat people who have ADHD and a number of medical concerns. Some infertility issues, just basically dealing with cancer or dealing with surgery, and also, people who have just basic anxiety and depression problems.

Nada Youssef:   Great. Thank you for being here. Now, humans are sexual beings, and like anything else in life, sex can pose some serious risks. It's up to us to have sex in a way that reduces any chances of getting sexually transmitted infections, diseases, or unplanned pregnancies. A healthy sex life includes understanding your body and how it works. You have to be comfortable with your body and your own sexual desires. We'll talk about that today. But I'm going to start off with some questions. Dr. Bradley, I would like to start this discussion regarding women, particularly over 40. As you age, your libido declines, or your estrogen declines. How do you keep your sex life going after 40?

Linda Bradley:   Well, I think sex should be vibrant from 40 until 100, until you leave this earth. And I also think that sex does not begin in the bedroom. Whether you're 35, 25, or 95, a lot of the issues that women have with libido and interests may have to do with lifestyle. What would that mean? Poor eating, being a little over their ideal body weight, having chronic conditions that make it more difficult to achieve orgasms sometimes because of being on medication or having interest. I think a healthy sex life begins with a healthy body, and also, I think an important component is conversation with a partner. I think I look at what's happening with a number of my patients. It's okay to be on medications, but sometimes our lifestyle is putting us on anti-depressants. Sometimes having surgical procedures that may have potentially affect one's sexuality. Lack of exercise. Depression. There's a whole host of things, and I think a healthy sex life begins with a healthy body and healthy relationships.

Nada Youssef:   Yeah. And it's all well-rounded, right? Do you have anything to add Dr. Brendza?

Dana Brendza:  Yeah, I agree with everything that Dr. Bradley said. The relationship is the foundation to a healthy sex life, and going along with that, I'd say that depending on what stage of life you're in, if you're looking to become pregnant and maybe having trouble getting pregnant, sometimes sex can become a chore. Sort of a science project, and you know, it's sometimes very difficult for a couple to have children. That can interfere. Fertility problems. Also, being pregnant. Once you've achieved the pregnancy and having particularly young kids, that that can really interfere with your sleep and just your ability to have any free time to spend with your partner.

Nada Youssef:   Now, I know you mentioned earlier, poor diet. Can we talk a little bit about poor diet? How does that affect sex life?

Linda Bradley:   Well, I think we all know that 70% of American's are over their ideal body weight. And I think of being overweight as being a time where just what's in our hips, our stomachs, where we're carrying extra weight. I look at this as areas of tissue that's not healthy. I look at myself. This stuff here it's not sleep, it's not dormant, and it's not hibernating. But it's making chemicals of inflammation, and so being overweight, we carry more inflammatory markers. What gets inflamed? Things in our brain. So stroke, heart attack, kidney problems, or joints. Everything. Sometimes doctors have to treat the chronic diseases that come from being overweight. Sometimes it's body image, in terms of how women look. Whether they've just had a baby or they're on medication that may make them gain weight.

And so I think lack of exercise, which can feed into why people are overweight, can lead to problems. When we think about ex ... And I'll just mention this as an aside, exercise, you know, what happens? Your heart rate goes up, more blood goes to your brain. We find that older people who exercise have less risk of Alzheimer's and dementia. When we exercise, blood goes to our genitals, and so that's very good also. I just find that when we look at things that we can do to help us with our sex life, weight is one thing. Decreasing alcohol, because it can actually be ... Yes, it's a stimulant, but also a depressant.

Being in relationships that are toxic or relationships way in the past that it had been associated with domestic violence or intimate partner violence. Or incest, and many things like that. When we look at women, women are more than the sum of their body parts. We have so many different things, and for women, unlike men, they just get an erection, and it's up and down. That's how we measure outcome from Viagra. For women looking at drugs and drug therapy, are we worried about the bathroom sink being dirty? Our hair not brushed. Our kids aren't having-

Linda Bradley:   More things that may sort of turn us on or turn us off, and so I think that when we just look at sexuality, it's such a big box. Pandora's Box that we sometimes have to open in order to make it where we're comfortable with our bodies, our relationships, and asking for what we want in the bedroom. What makes us comfortable, what gives us pleasure? What spots do I like to have touched that turn me on or turn me off, and so I think having that conversation is quite important.

Nada Youssef:   Sure, and then communication's very, very important.

Linda Bradley:   Very important.

Nada Youssef:   And one thing you guys talked about was pregnancy. You know, during pregnancy, your body looks different. After pregnancy, your body will still look different. Dr. Brendza, how do you deal with body image issues? I know you're a therapist. How do you deal with that? When someone has a body image, what do you say to them?

Dana Brendza:  Well, if their body has changed dramatically, say with say a weight gain or a procedure following a pregnancy, or a difficult birth. Or if they've had say a cancer surgery and now they have a colostomy bag or they have a mastectomy and they've had to endure some plastic surgery to help them to feel better about their body after the cancer was removed, we try to encourage people to talk with their partners, I guess to get reassurance that they're still valued and loved, and also that they're still attractive, and to help them to maybe go to a group for other people who have survived a similar issue so that they can, I guess process these feelings that they have about the changes that they're enduring and cope more effectively with those.

Nada Youssef:   Great. Now, sex. We're all trying to reach an orgasm. There are many women who can't reach an orgasm. Is it normal versus it is not? Is it bringing in an issue, or what do you do if you can't reach an orgasm? Can we talk a little bit about that?

Linda Bradley:   I think we have to demystify what an orgasm is-

Nada Youssef:   Yes. Please.

Linda Bradley:   And how it differs for men and for women. Many women are led to believe that penis in the vagina gives pleasure purely, whereas many women need manual stimulation, oral stimulation, use of vibrators, use of sex toys, to help achieve pleasure, because the clitoris, sometimes for many women, is the pleasure organ, and it may not be something that is felt as well with penis in the vagina. Some people can be brought to climax by touch, by kiss, by palpation of different body parts. From ears to elbows, to feet. I think people, women need to know what things bring pleasure or pain, and also, I think to have a partner that knows that the timeframe for orgasm in women may be very different in terms of how long it takes.

It's not ... Men can get aroused visually. That's why you've got pornography. It's very, very quick in terms of penile erections, in terms of what happens, but for women, it sometimes takes a longer time. And so the few guys that come to the office with their partners, I always ... If they're interested, show "Where is the clitoris? What has to be touched? How is it touched? What's the time of refractory period where after a while, you're not going to get a second orgasm in five minutes?" or something.

So I think knowing what is pleasurable and what is not pleasurable and how long it takes potentially to bring on pleasure, and what might dampen some of the pleasure-sensing nerves in terms of what's going on in that part of the body.  And there's also, you know, we think of intercourse. I think a lot of "outercourse."

Nada Youssef:   I like that.

Linda Bradley:   We definitely speak about that for teenagers.

Nada Youssef:   Yeah.

Linda Bradley:   How a lot of outercourse, if you want to be sexually active so you don't get pregnant if you're not using anything.

Nada Youssef:   Sure.

Linda Bradley:   I hope he moms are okay with that on this show. But I think that happens as we get older. I have couples where a man could have had prostate surgery, has had problems where he cannot maintain an erection, and people can feel as pleasurable in many ways. For many women, it starts outside of the bedroom. I just think somebody that's been screaming at all you day, upset, doesn't remember your birthday, and for men and for women, I tell my patients, "Let your partner help you in the kitchen. Let your partner help you with homework," and all the sort of mundane things that women have to do and chores, because a lot of that stuff leaves a whole bunch on our minds about-

Nada Youssef:   A lot of stress.

Linda Bradley:   ... what still needs to be done where you cannot relax. And so men who help cook and do things around the house get more sex. And women who have partners who do that are often more pleasurable because they can give up their full body. And to kind of also ... What I wish I had done, if my daughter's listening, it's okay. I should have had a lock on our door many years before, because and now we're having generations, sandwich generations where elderly family members are moving in, living in, because of economics, through death. There are many things that we can do to make our own bedrooms our own sanctuary, and so maybe sex in the shower and your tub. And different places. Sometimes it's a special weekend and ditch the kids and Grandma for a little while. 

Linda Bradley:   I'm just saying those are the things we have to sort of look at. To be creative. None of us eat rice the same way every day. And sex has to also be very different. You know, maybe today I want some spicy cayenne pepper on it, and another day, I want lemon pepper. That's how sex should be. You have to get out of the ordinary.

Nada Youssef:   And communication is key, right?

Linda Bradley:   And communication.

Nada Youssef:   It sounds like communication is key. Is there anything else you would like to add?

Dana Brendza:  Absolutely. I think something ... I was thinking of something that I often tell patients about the Five Love Languages book. Dr. Bradley was alluding to some of that with the acts of service, with doing things to make your partners life a little bit happier or easier. Doing something that's considerate of them. A lot of people feel loved when their partner notices that the dishwasher needs to be emptied or the trash needs to be taken out-

Linda Bradley:   Without being told.

Dana Brendza:  Exactly. I think the emptied dishwasher is the biggest aphrodisiac, really and truly. So spending quality time together is important. Having date night, like Dr. Bradley was alluding to. Also, learning to do physical touch in a way that your partner enjoys it. You know, it could be a scalp rub, a back massage, a foot rub. For someone who's on their feet a lot, that might be just pleasurable. And I'm thinking back to in a sex therapy course at my university where I was just fascinated to see something by a group of people who were paralyzed at the Kessler Institute in New Jersey. There was a couple who demonstrated how they learned to enjoy sexuality after the man was injured in a car accident.

Nada Youssef:   Oh, God.

Dana Brendza:  He was paralyzed from his neck down, and what became very sensual and very pleasurable for this gentleman was to have his hair rubbed and massaged. And they were making love in a shower, and they shared this with an audience just to educate us as medical students and psychology students about how the different ways couples manage to improvise when circumstances are such that it's limited. Their ability to enjoy sexuality.

Nada Youssef:   Because every individual's different, and as a couple, is different. So you gotta think about that.

Dana Brendza:  Right. Absolutely.

Nada Youssef:   Okay. Now I'm going to talk about painful sex. How do you know when you should see a physician versus like, you know, how painful is painful?

Linda Bradley:   I think sex should not be painful on a consistent basis. So we have to sort of look at when these things are most likely to happen. Sometimes after deliveries, if there's lacerations or episiotomies, or just the stretching from a vaginal delivery and/or C-section. It just hurts down there, so some of that might be a tincture of time with just four to six weeks of recovery. And also, women who are breastfeeding, we are encouraging moms to breastfeed exclusively if possible anywhere from four months to a year. When women breastfeed, the hormone levels are low.

Nada Youssef:   I see.

Linda Bradley:   If you breastfeed exclusively and on demand, often you don't get periods, and so the estrogens are low. Estrogen, I always think, is a hormone of lubrication. It creates moisture in the vagina. It also helps to provide increasing collagen and elastic and stretch of the vagina. Breastfeeding when the hormones are low.

If you're on chemotherapy and you stopped periods, you're not going to have estrogen. Also in the menopause and peri-menopause, the hormones are fluctuating, and so definitely after a woman stops having periods, which on the average in this country is from ages 51 to 58, it may hurt. Because the vagina, when you think about it stretching, I've delivered many single babies that are eight, nine, ten pounds. Twins, triplets, through the vagina. We know that the vagina has a big capacity for a baby’s head.

But afterwards, we even have four different size speculums. Sometimes as we get older, the vagina becomes rigid and elastic and as thin as your finger. And so we have to provide ... That hurts. If it's dry, I have patients who say it feels like Brillo and potato chips down there. We have to provide moisture and hydration, much like we do for our skin and hands. Part of it could be cyclical based upon, for pain, with the lack of estrogen, and we think of all the different ... There's certain medicines. Even things like antihistamines. If are using it all the time to dry out your sinuses, you can dry out the vaginal-

Nada Youssef:   You can dry out.

Linda Bradley:   ... moisture. So there, when I think about it, there can be many things besides just hormonal. Drug therapy, chemotherapy, but also age-related factors.

Nada Youssef:   Now, how about bleeding. Is bleeding ever normal after sex?

Linda Bradley:   No. It's never normal. And the things that we think about, sometimes the tissue, the vagina gets to be like parchment paper. It's just thin. And it's just like as we get older, we can see our arteries and veins more easily. The penis and the vagina, vibrator in the vagina, finger in the vagina, it's going to make that skin that's very thin and fragile, crack and fissure and break. We also have to think it's rare to have vaginal cancer. It's rare now to see cervical cancer in women who are having routine-

Nada Youssef:   Checkups.

Linda Bradley:   ... screenings with their Pap smear. It could be many different things. I think if it's persistent or heavy, that's when you do need to see a physician. And I always say we can't play telephone medicine with it. Some visits really require that a doctor [crosstalk 00:18:21] look and see what's going on, and that would be a certain case.

Nada Youssef:   Great. Thank you. Okay, Dr. Brendza, I want to talk a little bit about the psychology behind it. The sex therapy. You know, a lot of time people feel strange or maybe something's going on behind closed doors that's maybe a little weird, that you have to see a therapist. But can you talk a little bit more about the psychological side of sex and sexuality and why it's healthy to see a psychologist?

Dana Brendza:  Yes. I mean, sex is a very natural, desirable part of any relationship. Particularly if a pair of people are committed to each other, it's ideal if they're sexually active with each other if they're expecting monogamy from their partner. I see ordinary, just ordinary regular people, some of it is sort of like plumbing problems. Some it has to do with phase of life problems. Or maybe developing some anxiety about their ability to function and once it begins, it's difficult to be mindful and sort of in the moment, and to enjoy sexuality the way you used to, because you're wondering, "Gee, is this going to work," or "Is my partner still attracted to me," or "Do I look appealing since I had this procedure or this surgery?" That sort of thing.

I think what Dr. Bradley was alluding to earlier ... It's important to keep some variety in our sex lives, and there are books, lots of them, just for regular mated people who are middle-aged and just ordinary folks. It's just not vanilla sex that people are having, and it's important to try some variety, to look on websites. Even search on Amazon for something interesting that might be sort of fun and novel to add some different kind of different stimulation. Maybe an outfit or a book where you have a sealed seduction, and you kind of do something different and do a role play. There are dice games that you can play with your partner. That sort of thing. Scented massage oil and learning different massage techniques. Buying vibrators and things like that. It's-

Nada Youssef:   Keeping it different and new.

Dana Brendza:  Exactly. There are lots of ways to spice things up. When people come to me, a lot of times, something's gone wrong. Maybe somebody has gone outside the partnership or the marriage, and they're having difficulty with trusting, so that has to be rebuilt. But when an affair occurs, usually there was a problem in the relationship, and you know, both people are contributing to that problem, so it's a couple’s issue, and they need to fix the relationship. Your sex organs, your brain and your heart, I'd say, are more important than the penis and the vagina, honestly.

Nada Youssef:   Yes, I agree. Okay, I have one more question for you, and then we're going to go to some live questions. What to expect from my first therapy session, and should I come alone or do I bring my partner?

Dana Brendza:  You can bring your partner if you want. It's sort of difficult sometimes for both of you if you're both working or there are children to care for. Sometimes it's difficult for most people to come into the office. The person who's, "the identified patient," say the person with the erectile issue or the painful intercourse might be the one who shows up, but I often invite people to bring their partner with them to future sessions. One might expect just a basic interview the way you would with an ordinary therapist, just finding out about say, background issues. How did you get introduced to sexuality? What's your orientation? Are you comfortable in the body that you were born into? Did you have any unfortunate incidents where you were mistreated sexually? In your current relationship, are you feeling safe or are you feeling attractive? Are you feeling valued and loved and appreciated?

Nada Youssef:   Yeah. You're getting right deep in these questions. Great. I'm going to go to some live questions. I have Crystal. Can you offer any help with PMDD? Premenstrual-

Linda Bradley:   Dysphorics disorder.

Dana Brendza:  Disorder.

Nada Youssef:   Dysphoric disorder.

Linda Bradley:   That's a syndrome in women who menstruate who have anxiety, depression, difficulty focusing, and mood changes. It is a real disorder. There's not a blood test for it. They're most often ... There are two different roles for therapy. Some doctors will put women on chronic birth control pills, where their hormone levels are monotonous and stay the same. Sometimes, and many times for that disorder, we also may treat with anti-depressants. And there are some other extraneous things that we do, but PMS is usually, which is not as severe.

PMS are usual symptoms, there are 150 symptoms, including PMDD, cravings, just many different things. Thoughts, sleep problems. But those, the PMS, unlike PMDD, occurs about a week or so before the cycle. As soon as the woman starts her period, all the depression, anxiety, irritability, goes away. PMDD is longer. It's a little, it's hard ... Is it Crystal? I forget her name.

Nada Youssef:   Yeah, it's Crystal.

Linda Bradley:   To answer exactly, it's not in your head. There are people who can sometimes do talk therapy, and sometimes there's the magic with medication. And so sometimes it's a combination of things, and there is help for it. When I was in med school long ago, it was said, "Oh, we can't measure a blood test for it." They do ... It's nothing that's going to come up, but there is good therapy. We want to rule out things like low thyroid function. If someone's very, very anemic in terms of feeling sluggish. But once some basic labs are done, then you'd begun either with talk therapy and then medical treatment with beginning at baby doses of medicine and changing over time. Most of the anti-depressants, you do not get better by swallowing one pill. We tell patients they have to be patient, and it can take four, six, to eight, weeks at a certain dose, and then before we sort of titrate to different levels.

Nada Youssef:   Sure. Very helpful. Thank you.

Linda Bradley:   Mm-hmm (affirmative).

Nada Youssef:   Thank you, Crystal, for your question.

Linda Bradley:   And exercise.

Nada Youssef:   Exercise.

Linda Bradley:   I'm always going to put exercise in all of that. I mean, it's not always not one thing fits everybody, and I can't think of ... Well, I'm sure there's something, but very few things for which exercise does not make better in terms of serotonin levels. Things the happy drugs that your whole own body and brain make.

Nada Youssef:   Sure, sure. Great. Thank you. I have one. I am a 60-year-old female, and nine years ago, I had a complete hysterectomy due to endometrial cancer. I'm thankful to be cancer-free, but I must confess that I have zero libido. Zero interest in sex. I exercise several times a week, and I'm generally healthy. I'm really not interested in taking medication for this issue, just interested in your comments.

Linda Bradley:   Well, first of all, I'm happy that you're a survivor for the nine years for endometrial cancer, and lack of interest could be hormonal, and the symptom that you're having, you might have had anyhow without surgery, because now you're without any hormones, and most 60-year-olds are without it. Sometimes women aren't interested because of pain, and I didn't mention this. If you think you're going to have pain with intercourse, just like some women always get bladder infections and yeast infections, we can treat that.

Some people are avoiding that because it creates this vicious cycle. If the reason for avoiding or part of a reason could be pain, I didn't mention there's pills, patches, potions, different things we can put into the vagina or take orally to help with hydration. And the vagina gets very pale, white, yellow, instead of having this beautiful pink color like your tongue or the underneath of your eyes. It is safe. And again, I think when patients have the "C" word, the "cancer" word, you have to always talk with your physician. But it is safe to use topical, intra-vaginal estrogens to provide hydration. There are many different products on the market from things called, "Wet," to Replens. There's something called Astroglide which our tax dollars help ... It's a sex lubricant made and developed through NASA, where-

Nada Youssef:   Oh.

Linda Bradley:   Yeah. It's very ... NASA's right outside of Cleveland. And one of the guys, this is a true story, was trying to come up with something to decrease friction from the ball bearings that go up in the spaceship. So he created this lubricant, and he just told his mom who was 60 about it. Odorless, tasteless, it adds moisture, and it's now you can buy it, and your tax dollars for NASA can help your sex life. So Astroglide-

Nada Youssef:   That's amazing.

Dana Brendza:  It is amazing.

Linda Bradley:   There's probably, I mean, there's K-Y Jelly. I tell patients, I just came from a conference and kind of a little bit of a potpourri of different things that you can put on your skin. It's like what I use for my hair or my face, you may not like my moisturizer, but I love what I use, okay?

Nada Youssef:   Yes.

Linda Bradley:   So you have to ... I tell patients to try, put it on their skin, and try it.

Nada Youssef:   Sure.

Linda Bradley:   The other would be, there are some non-hormonal medications that you would speak with your doctor about. I don't know if I'm supposed to be pushing these names or anything, so what I would say is, Estrogen, I mean sorry, endometrial cancer, nine years out, is not a contraindication for many different medical therapies, and there are some new therapies for women. We are not ... There's a new medications that increase libido for women that you would talk with your physician about. I don't know if I should mention names on this or not, but your doctors would know.

Nada Youssef:   Okay. Great. And then, so cancer, sex. Anything you want to bring to the table with kind of like the mental-

Dana Brendza:  Sure. With the behavioral stuff. Let's see. I think that sometimes if you're in a committed relationship, and I'm not sure that the woman who asked the last question about having survived cancer is, I don't think she mentioned whether or not she's with a-

Nada Youssef:   If she's married.

Dana Brendza:  ... partner. But in those situations, say you're with a partner and they're still interested, and sometimes a person can go along with the suggestion that a couple behaves in an intimate way, and the other person might not initially be in the mood for it. It's sort of like if your partner says, "I'm in the mood for some ice cream. Let's go the Mitchell's and have some wonderful ice cream. If we're going to blow it, let's have some good stuff." Maybe they would like to engage in something sexual. Well, maybe the idea hadn't occurred to you but now that they mention it, it sounds like a nice idea.

At the sex therapy class, someone who was an older woman at the time taught us about the concept of the unilateral. And it's okay sometimes to give sexual pleasure to your partner even if you're not quite in the mood. I mean, you can request. If you're monogamous together and you want your partner to feel better, to have an orgasm, to have some pleasure, it's okay to say, "No thanks. I'm kind of good, but I'd really like to do this for you. It makes me feel happy to provide you the unilateral." That's always an appreciative thing-

Nada Youssef:   Great. Dawn, after a hysterectomy, is a vaginal exam needed?

Linda Bradley:   Vaginal exam, well after a hysterectomy, if you're under a certain age, we usually leave the ovaries, so we do a vaginal exam just to ... We call it a bimanual exam to check ovarian status and size. What she may be asking about is a Pap smear needed? I'm not sure if that's-

Nada Youssef:   A vaginal exam.

Linda Bradley:   But I would say a vaginal exam, yes, if you still have the ovaries. And any complaints vaginally. Dryness, itching, odor, discharge. And if you had a hysterectomy for a precancer or cancer, we still look.

Nada Youssef:   Okay.

Linda Bradley:   We do not do a Pap test after a hysterectomy if the hysterectomy was not done for cancer.

Nada Youssef:   I see.

Linda Bradley:   It used to be we would do Pap test, but a Pap test is a screening test for cervical cancer, and there's usually no cervix.

Nada Youssef:   Sure.

Linda Bradley:   Both of the ways the hysterectomies are done. They're not a cervix. There's no cervix present. If they had what's called a supracervical hysterectomy, some women ask the doctors to keep the cervix because they think it helps to increase vaginal support and may affect sexuality. If the cervix is left, then yes, you would be on a periodic basis. Normally now we're going Paps every five years up until about age 65 or 70.

Nada Youssef:   Very good. Thank you. And I have Jessica. I have severe adhesions from years of pelvic surgeries for different reasons. I had a hysterectomy for pain, and the surgeon said my cervix was attached to my bladder, and he would not attach it. I still have uncomfortable pain with intercourse. Is there anything you would recommend to try?

Linda Bradley:   No. If you're in the Cleveland area, we have a phenomenal chronic pelvic pain clinic.

Nada Youssef:   Yes.

Linda Bradley:   I don't think more surgery, and I'm not your physician and I don't know your operative note, but we sometimes have to look at non-surgical therapies. At Cleveland Clinic Main Campus here in Cleveland, if you were to call for an appointment, and we also do virtual visits now, at least to sort of do, excuse me, a meet and greet with a physician, but I would say if someone's had multiple surgeries, then look at alternatives, and ask for the GYN Chronic Pelvic Pain.

We have two physicians. World leaders, national leaders in this, and there's often something that can be done. Not all pain comes from adhesions. We're finding that the pelvis is like a bowl with many muscles, lymphatics, and nerves. And some patients get tension on the pelvic floor muscles. We've had many women who've gone through hysterectomies for pain and still have pain. Didn't have adhesions, and we do physical therapy for the pelvic floor to help relax those muscles and some different things. Innervation, there's just many different things that they can do.

Nada Youssef:   Great. Thank you. Well, unfortunately, we're out of time, but I could keep going forever. But I'm going to let you guys have the floor. If there's anything you would like to add to viewers that maybe we haven't touched on. Is there anything that you guys would like to add?

Dana Brendza:  Well, we kind of touched on a few ... Anything you want to say?

Linda Bradley:   Oh, did you want to go first? Okay.

Dana Brendza:  Go ahead.

Linda Bradley:   So I think as women, we are sexual beings. I'm happy that this topic is being explored. I think too often so much is kept in the closet, and I think it's important to begin, if for yourself, well this may be a little bit late, but look at sexual safety for your daughters, nieces, girls that you love. Be a mother when you're ready to become a mother, and take the issue of sexuality and pregnancy especially when you're young, very seriously. Do you want to be pregnant, or do you want to be a mom? Because I think when we look at sexuality, it's important to differ between the two. If you see a girl in trouble, being taken advantage of who talks to you about being sexually abused, there's this whole thing now with the "Me Too" movement which is a real movement, and I honor that movement. That we look at these issues very, very cautiously and carefully and get help.

Nada Youssef:   Thank you. Thank you so much. This is all very good information. And for more health tips information, make sure you follow us on Facebook, Twitter, Instagram, and Snapchat at ClevelandClinic, just one word, and we'll see you again next time.

This concludes this Cleveland Clinic Health Essentials Podcast. Thank you for listening. Join us again soon.